Keto, blood surgar, cholesterol, protein--how to balance?

[carriex3]

Hi!

I've read portions of Dr. Bredesen's book, read posts here and met with a nutritionist. Where I am struggling is how to balance everything.

Despite historically eating pretty well an exercising regularly, my cholesterol is too high (LDL high, HDL low) and I have signs of insulin resistance. I'm also APOE 3/4.

I'm willing to do what it takes to put the odds in my favor, both in terms of AD and heart disease. However, when I do the intermittent fasting and attempt to get to Keto, I struggle to get enough protein (70g minimum, according to my nutritionist). If I get enough protein, I think I'll make my lipids worse and somewhat go against the Bredesen protocol.

Any tips?

[apod]

Welcome to the forum!

Adding a bit more seafood/shellfish or lean protein to your diet would increase the amino acid intake without adding much in the way of SFA or cholesterol (if you are in fact, a hyper-responder to these.) Alternatively, if you're merely looking to add protein to a keto diet, something like supplemental bone broth protein, collagen peptides, rice/hemp/pea, or whey would top off your intake. While a tight eating window is a great goal to have, a more relaxed 10-12hr window still offers benefits and may help you better meet your nutritional needs.

I've heard Dr. Gundry mention bone broth protein having the potential to increase IGF-1, but I've also seen IGF-1 listed as being neuroprotective (https://www.ncbi.nlm.nih.gov/pubmed/11205145) -- it might be worth measuring IGF1 if you have some sort of concern there. Mine tends to run quite low, despite my protein intake.

In theory, since a keto diet is muscle-spacing and a higher protein intake can be counter-productive (via gluconeogenesis), a low to moderate intake should be perfectly adequate, unless you're very muscular and/or active. Resistance training adds an additional protein-sparing effect on lean muscle mass.

For what it's worth, my lipids ran the lowest while I was on my highest protein intake and they ran the highest for me when I was on my highest saturated fat intake. So it might be worth disassociating these two macronutrients, as the source of the protein might have a greater effect than the quantity.

How's your BMI / activity / sleep? These are low-hanging fruit for improving insulin sensitivity and lipid balance.

[Julie G]

I struggle to get enough protein (70g minimum, according to my nutritionist). If I get enough protein, I think I'll make my lipids worse and somewhat go against the Bredesen protocol.

carriex3, welcome! That seems like a lot of protein to me. Dr. Bredesen recommends between 0.8-1.0 grams (g) per kilogram (kg) of lean body mass (LBM) daily. You can use this calculator to determine your LBM. Divide by 2.2 for your weight in kg. I'm 5'9" and weight 128. My LBM is 108.5, rounded up to 109. Divided by 2.2; I weigh 49.5 kg and try to target 49.5 g of protein daily. This limit only applies to animal protein. Those who have ongoing GI issues, chronic infections (i.e Type 3 AD), high metabolic demands from strenuous work or exercise or those over age 65 may need 10-20% more.

[BrianR]

I struggle to get enough protein (70g minimum, according to my nutritionist). If I get enough protein, I think I'll make my lipids worse and somewhat go against the Bredesen protocol.

carriex3, welcome! That seems like a lot of animal protein to me. ...

I hate to not totally agree with Julie, since she knows so much more than I do (and thus, take my opinions with several grains of salt).

It's good to remember that you can get an appreciable amount of protein from non-animal, non-carb/gluten sources. For example seeds and nuts, or tempeh (which I know not everyone will eat), along with modest contributions from a variety of vegetables which aren't potatoes.

Also, everyone's body is different. I'm probably overly thin and have a hard time maintaining my weight without consuming a higher than Bredesen-protocol protein level. (Although I do try to moderate and mix the animal proteins.) You should ask your nutritionist why they believe you need to get 70g per day. If it's just accepted wisdom, then maybe you could go lower - if you can still maintain muscle mass at lower levels, then it's probably all for the better.

[apod]

I came across this study published last week in American Journal of Clinical Nutrition.

Effects of red meat, white meat, and nonmeat protein sources on atherogenic lipoprotein measures in the context of low compared with high saturated fat intake: a randomized controlled trial.

https://medicalxpress.com/news/2019-06- ... y-bad.html
https://academic.oup.com/ajcn/advance-a ... 35/5494812

"When we planned this study, we expected red meat to have a more adverse effect on blood cholesterol levels than white meat, but we were surprised that this was not the case—their effects on cholesterol are identical when saturated fat levels are equivalent," said the study senior author Ronald Krauss, M.D., senior scientist and director of Atherosclerosis Research at CHORI.

TMAO production, Neu5Gc, and heme-iron represent additional red meat health concerns. If you are going to increase your vegetable-based protein consumption, you might look into pressure cooking legumes and soaking / sprouting nuts & seeds.

[Julie G]

I hate to not totally agree with Julie, since she knows so much more than I do (and thus, take my opinions with several grains of salt).

LOL, pease disagree. I greatly respect your perspective, Brian! I didn't mean to imply that Dr. Bredesen insists on animal protein, but rather that his limit only applies to animal protein. (I edited my response above to clarify.) All plants have protein and he encourages the the use of whole food plant protein as an excellent substitute for animal protein. He just doesn't limit plant protein in the same way. FWIW, I've also had to eat higher amounts in the past, but am currently doing well with this recommendation.

[DebS]

Hi!

I've read portions of Dr. Bredesen's book, read posts here and met with a nutritionist. Where I am struggling is how to balance everything.

Hi carriex3, and welcome!

It sounds as if you are jumping right in to make positive change. You have received excellent information in regard to protein consumption above. If you haven't yet found it, our primer is a great place to start for an overview of the site as well as a prioritized list of preventative strategies. You will find links to deeper dives on various topics in our Wiki. We would love to hear more about you in Our Stories if you feel like sharing.

I look forward to your future posts. Please reach out if you have questions.

[carriex3]

Welcome to the forum!

Adding a bit more seafood/shellfish or lean protein to your diet would increase the amino acid intake without adding much in the way of SFA or cholesterol (if you are in fact, a hyper-responder to these.) Alternatively, if you're merely looking to add protein to a keto diet, something like supplemental bone broth protein, collagen peptides, rice/hemp/pea, or whey would top off your intake. While a tight eating window is a great goal to have, a more relaxed 10-12hr window still offers benefits and may help you better meet your nutritional needs.

I've heard Dr. Gundry mention bone broth protein having the potential to increase IGF-1, but I've also seen IGF-1 listed as being neuroprotective (https://www.ncbi.nlm.nih.gov/pubmed/11205145) -- it might be worth measuring IGF1 if you have some sort of concern there. Mine tends to run quite low, despite my protein intake.

In theory, since a keto diet is muscle-spacing and a higher protein intake can be counter-productive (via gluconeogenesis), a low to moderate intake should be perfectly adequate, unless you're very muscular and/or active. Resistance training adds an additional protein-sparing effect on lean muscle mass.

For what it's worth, my lipids ran the lowest while I was on my highest protein intake and they ran the highest for me when I was on my highest saturated fat intake. So it might be worth disassociating these two macronutrients, as the source of the protein might have a greater effect than the quantity.

How's your BMI / activity / sleep? These are low-hanging fruit for improving insulin sensitivity and lipid balance.

Thank you for the thoughts! Looks like I have some reasearch to do on IGF-1. I am new to all of this.

Regarding BMI/activity and sleep, all are good. BMI of 22.5, I exercise everyday (usually running) and sleep 8 hours.

I just bought pea protein powder and some tempeh, so I'm experimenting!

[apod]

I'm not promoting a higher protein intake or protein supplement, however, these guys make a decent product (although, it's out of stock): https://www.nutrabio.com/product/OPP/ a serving comes with 2 grams of carbohydrates, one of which is fiber. Vegan protein is a bit easier to handle with enzymes. I don't quite see the point of the "636 milligrams of hemp protein" (?) but the mushroom blend is a nice touch. LivingFuel, Thorne, and MRM have nice products as well. When I use these, I'll often tack on something like cacao powder or ground flax along with tempt hemp milk, where you can sort of dial up the polyphenols, fiber, and micronutrient content.

Straight, unflavored vegan protein can be a little rough.

I'm a proponent of pantethine as a source of B5, which has a positive effect on lipids while also being neuroprotective. The effect is subtle, but it's a nudge in the right direction. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5575230/

[Julie G]

FWIW, Dr. B gives a thumbs up to organic tempeh and a thumbs down to pea protein or any protein powder or supplement. The idea is to get protein through whole foods. Despite the fact that it's processed, tempeh is a particularly good choice as it's fermented which will help to alleviate the inflammatory effect from the lectins. As you probably already know, all soy is GMO unless labelled USDA organic/non-GMO.